massive eyebrows lady had a great murmur that you could almost hear without your stethoscope. her lungs were filled with crackles and her troponin was 15. but she also had a low ph, a bsl of 24 and a tongue as dry as the sahara. i gave her some fluids and she got better than she got worse. her family gathered around with frowns and said they wanted full resuscitation. palliative care fail.
gcs 4 man came in with a fever and a raised troponin. he had a shearer blue singlet on and a permanent trache thanks to a floor of mouth scc. he had no neck (dissected away long ago) and no blood pressure. he also had no massive intracranial haemorrhage or cerebral mets on ct, which we were rather hoping to find. so we had to take him to icu because the ward couldnt manage his sats of 78%. yet another palliative care fail.
bmi 40+ man had no neck either. but he did have a pco2 of 113. his family attempted to keep him awake while we put him on bipap and tried to reverse his warfarin so we could tap his pleural effusion. finally at 11pm we decided to bite the bullet and tube him. the anaesthetist didnt want to come in but in the end she relented. perhaps it was the confidence (or was it panic) in my voice. thankfully it only took her three goes to tube him with the bougie. she also left me to check the tube position, put in a ngt to decompress his stomach, make up the ventilator settings, write up sedation, work out which inotrope to use (i wasn't too thrilled with a sbp of 65) and talk to the family. fortunately, it seemed that i had learnt something from my icu rotation after all (entirely through osmosis of course). and the icu nurses were very patient. another life saved.
but now i have a cold. hooray!
4 comments:
But are you not pleased? The sweet pathology... the elation of ever-deepening crisis... You are a lucky man indeed.
tell me more about the airway? what grade view was it? was the patient properly positioned? did anyone attempt a ILMA? what was the bicarb?
yeeeek
thank goodness i am in subacute
the thought of running code blues makes me want to pass out
haha
it is kinda cool running around managing all these sick patient myself. it is also kinda freaking me out! bmi40+ man extubated himself last week and now has a trache. massive eyebrows lady went to melbourne for a valve replacement. and gcs4 man is now gcs11 man - i changed his peg tube on the ward yesterday. but when i commented to his wife how fantastic he looks and how much he had improved, she just shrugged and looked at me with sorrowful eyes. he'll never be less than high level care now.
sigh.
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